Assessment of Frailty Index at 66 Years of Age and Association With Age-Related Diseases, Disability, and Death Over 10 Years in Korea.
Assessment of Frailty Index at 66 Years of Age and Association With Age-Related Diseases, Disability, and Death Over 10 Years in Korea.
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DOI：
10.1001/jamanetworkopen.2022.48995
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发表时间：
2023-03-01
影响因子：
13.8
通讯作者：
Kim, Dae Hyun
中科院分区：
文献类型：
--
作者：
Jang, Jieun;Jung, Heewon;Shin, Jaeyong;Kim, Dae Hyun
在66岁时衡量脆弱指数是否与发病年龄相关的慢性病、残疾和死亡有关？这项对968名 885韩国人进行的全国性队列研究发现，在66岁时测量的虚弱指数与更高的死亡率、新的与年龄相关的重大疾病以及10年内符合残疾资格的长期护理服务相关。虚弱与获得与年龄相关的新疾病的速度更快有关。这些发现表明，在66岁时测量虚弱程度提供了一个人可能会遵循的老龄化轨迹，这可能有助于缓解与老龄化相关的健康下降。这项队列研究考察了韩国人口在66岁时的脆弱指数与一系列与年龄相关的重大疾病、残疾和10年后死亡的发展之间的关系。一个脆弱指数被提出作为衡量老年人衰老的指标。然而，很少有研究检验在较年轻的相同年龄段测量的脆弱指数是否可以预测新的年龄相关疾病的发展。为了检验66岁的脆弱指数与10年来发生的与年龄相关的疾病、残疾和死亡的关联，这项回溯性的全国队列研究使用韩国国家健康保险数据库确定了968名 885韩国人，他们在2007年1月1日至2017年12月31日期间参加了66岁的国家过渡年龄筛查计划。对2020年10月1日至2022年1月的数据进行了分析。脆弱由39项脆弱指数定义，范围为健壮(0.15)、脆弱(0.15-0.24)、中度脆弱(0.25-0.34)和中度至重度脆弱(≥0.35)。主要结果是全因死亡。次要结果是8种与年龄相关的慢性疾病(充血性心力衰竭、冠状动脉疾病、中风、2型糖尿病、癌症、痴呆症、跌倒和骨折)以及有资格获得长期护理服务的残疾。使用COX比例风险回归、特定原因和次分布风险回归来检验结果的危险比(HR)和95%的CI，直到死亡日期、相关年龄相关疾病的发生、筛查检查后10年或2019年12月31日。在纳入分析的968885名参与者(517名 052名妇女[53.4%])中，大多数人被归类为健壮(65.2%)或早衰(28.2%)；只有一小部分被归类为中度虚弱(5.7%)或中度至重度虚弱(1.0%)。平均脆弱指数为0.13(SD，0.07)，415(6.6%)为虚弱。与健康组相比，中度至重度衰弱组更有可能是女性(47.8%比61.7%)，接受低收入医疗援助保险(2.1%比18.9%)，以及不太活跃(中位数，657[IQR，219-1133]比319[IQR，0-693]代谢等值任务[min/wk])。在调整了社会人口学和生活方式特征后，中到重度虚弱与死亡率(HR，4.43[95%CI，4.24-4.64])和所有慢性病的新诊断有关，包括充血性心力衰竭(调整后的原因特定HR，2.90[95%CI，2.67-3.15])，冠状动脉疾病(调整后的原因特定HR，1.98[95%CI，1.85-2.12])，中风(调整后的原因特定HR，2.22[95%CI，2.10-2.34])，糖尿病(调整后原因特定心率，2.34[95%CI，2.21-2.47])、癌症(调整后原因特定HR，1.10[95%CI，1.03-1.18])、痴呆(调整后原因特定HR，3.59[95%CI，3.42-3.77])、跌倒(调整后原因特定HR，2.76[95%CI，2.29-3.32])、骨折(调整后原因特定HR，1.54[95%CI，1.48-1.62])，残疾(调整后的特定原因HR，10.85[95%CI，10.00-11.70])。除癌症外，虚弱与所有结果的10年发病率增加有关(调整后的中度至重度脆弱次分布比，0.99[95%CI，0.92-1.06])。在接下来的10年里，66岁的虚弱与更多的与年龄相关的疾病的获得有关(健康组的平均[SD]条件，每年0.14[0.32]；中度到重度虚弱的组，0.45[0.87])。这项队列研究的结果表明，在66岁时测量的脆弱指数与在接下来的10年里加速获得与年龄相关的疾病、残疾和死亡有关。在这个年龄段测量虚弱程度可能会提供防止与年龄相关的健康下降的机会。
Is a frailty index measure at 66 years of age associated with incident age-related chronic disease, disability, and death? This nationwide cohort study of 968 885 Korean individuals found that a frailty index measured at 66 years of age was associated with greater rates of death, new major age-related diseases, and disability-qualifying long-term care services over 10 years. Frailty was associated with faster acquisition of new age-related conditions. These findings suggest that measuring frailty at 66 years of age provides an aging trajectory that one is likely to follow, which may be useful to mitigate health decline associated with aging. This cohort study examines the association of a frailty index at 66 years of age with development of a range of major age-related diseases, disability, and death over 10 years in the population of Korea. A frailty index has been proposed as a measure of aging among older individuals. However, few studies have examined whether a frailty index measured at the same chronologic age at younger ages could forecast the development of new age-related conditions. To examine the association of the frailty index at 66 years of age with incident age-related diseases, disability, and death over 10 years This retrospective nationwide cohort study used the Korean National Health Insurance database to identify 968 885 Korean individuals who attended the National Screening Program for Transitional Ages at 66 years of age between January 1, 2007, and December 31, 2017. Data were analyzed from October 1, 2020, to January 2022. Frailty was defined using a 39-item frailty index ranging from 0 to 1.00 as robust (<0.15), prefrail (0.15-0.24), mildly frail (0.25-0.34), and moderately to severely frail (≥0.35). The primary outcome was all-cause death. Secondary outcomes were 8 age-related chronic diseases (congestive heart failure, coronary artery disease, stroke, type 2 diabetes, cancer, dementia, fall, and fracture) and disability qualifying for long-term care services. Cox proportional hazards regression and cause-specific and subdistribution hazards regression were used to examine hazard ratios (HRs) and 95% CIs for the outcomes until the earliest of date of death, the occurrence of relevant age-related conditions, 10 years from the screening examination, or December 31, 2019. Among the 968 885 participants included in the analysis (517 052 women [53.4%]), the majority were classified as robust (65.2%) or prefrail (28.2%); only a small fraction were classified as mildly frail (5.7%) or moderately to severely frail (1.0%). The mean frailty index was 0.13 (SD, 0.07), and 64 415 (6.6%) were frail. Compared with the robust group, those in the moderately to severely frail group were more likely to be women (47.8% vs 61.7%), receiving medical aid insurance for low income (2.1% vs 18.9%), and less active (median, 657 [IQR, 219-1133] vs 319 [IQR, 0-693] metabolic equivalent task [min/wk]). After adjusting for sociodemographic and lifestyle characteristics, moderate to severe frailty was associated with increased rates of death (HR, 4.43 [95% CI, 4.24-4.64]) and new diagnosis of all chronic diseases, including congestive heart failure (adjusted cause-specific HR, 2.90 [95% CI, 2.67-3.15]), coronary artery disease (adjusted cause-specific HR, 1.98 [95% CI, 1.85-2.12]), stroke (adjusted cause-specific HR, 2.22 [95% CI, 2.10-2.34]), diabetes (adjusted cause-specific HR, 2.34 [95% CI, 2.21-2.47]), cancer (adjusted cause-specific HR, 1.10 [95% CI, 1.03-1.18]), dementia (adjusted cause-specific HR, 3.59 [95% CI, 3.42-3.77]), fall (adjusted cause-specific HR, 2.76 [95% CI, 2.29-3.32]), fracture (adjusted cause-specific HR, 1.54 [95% CI, 1.48-1.62]), and disability (adjusted cause-specific HR, 10.85 [95% CI, 10.00-11.70]). Frailty was associated with increased 10-year incidence of all the outcomes, except for cancer (moderate to severe frailty adjusted subdistribution HR, 0.99 [95% CI, 0.92-1.06]). Frailty at 66 years of age was associated with greater acquisition of age-related conditions (mean [SD] conditions per year for the robust group, 0.14 [0.32]; for the moderately to severely frail group, 0.45 [0.87]) in the next 10 years. The findings of this cohort study suggest that a frailty index measured at 66 years of age was associated with accelerated acquisition of age-related conditions, disability, and death over the next 10 years. Measuring frailty at this age may offer opportunities to prevent age-related health decline.
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影响因子：
64.5
作者：
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通讯作者：
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DOI：
10.1093/gerona/glx229
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